# The Body Keeps the Score  Author:: Bessel van der Kolk MD  ## AI-Generated Summary None ## Highlights > This vast increase in our knowledge about the basic processes that underlie trauma has also opened up new possibilities to palliate or even reverse the damage. We can now develop methods and experiences that utilize the brain’s own natural neuroplasticity to help survivors feel fully alive in the present and move on with their lives. There are fundamentally three avenues: 1) top down, by talking, (re-) connecting with others, and allowing ourselves to know and understand what is going on with us, while processing the memories of the trauma; 2) by taking medicines that shut down inappropriate alarm reactions, or by utilizing other technologies that change the way the brain organizes information, and 3) bottom up: by allowing the body to have experiences that deeply and viscerally contradict the helplessness, rage, or collapse that result from trauma. Which one of these is best for any particular survivor is an empirical question. Most people I have worked with require a combination. ([Location 274](https://readwise.io/to_kindle?action=open&asin=B00G3L1C2K&location=274)) ### Part One The Rediscovery of Trauma Chapter 1 Lessons from Vietnam Veterans > Trauma, whether it is the result of something done to you or something you yourself have done, almost always makes it difficult to engage in intimate relationships. After you have experienced something so unspeakable, how do you learn to trust yourself or anyone else again? Or, conversely, how can you surrender to an intimate relationship after you have been brutally violated? ([Location 424](https://readwise.io/to_kindle?action=open&asin=B00G3L1C2K&location=424)) #### Chapter 2 Revolutions in Understanding Mind and Brain > When their serotonin levels rose, many of my patients became less reactive. ([Location 886](https://readwise.io/to_kindle?action=open&asin=B00G3L1C2K&location=886)) #### Chapter 3 Looking into the Brain: The Neuroscience Revolution > Our study clearly showed that when traumatized people are presented with images, sounds, or thoughts related to their particular experience, the amygdala reacts with alarm—even, as in Marsha’s case, thirteen years after the event. Activation of this fear center triggers the cascade of stress hormones and nerve impulses that drive up blood pressure, heart rate, and oxygen intake—preparing the body for fight or flight.[1] ([Location 1017](https://readwise.io/to_kindle?action=open&asin=B00G3L1C2K&location=1017)) > Our most surprising finding was a white spot in the left frontal lobe of the cortex, in a region called Broca’s area. In this case the change in color meant that there was a significant decrease in that part of the brain. Broca’s area is one of the speech centers of the brain, which is often affected in stroke patients when the blood supply to that region is cut off. Without a functioning Broca’s area, you cannot put your thoughts and feelings into words. ([Location 1023](https://readwise.io/to_kindle?action=open&asin=B00G3L1C2K&location=1023)) > When words fail, haunting images capture the experience and return as nightmares and flashbacks. In contrast to the deactivation of Broca’s area, another region, Brodmann’s area 19, lit up in our participants. This is a region in the visual cortex that registers images when they first enter the brain. We were surprised to see brain activation in this area so long after the original experience of the trauma. ([Location 1042](https://readwise.io/to_kindle?action=open&asin=B00G3L1C2K&location=1042)) > The stress hormones of traumatized people, in contrast, take much longer to return to baseline and spike quickly and disproportionately in response to mildly stressful stimuli. ([Location 1087](https://readwise.io/to_kindle?action=open&asin=B00G3L1C2K&location=1087)) ### Part Two This Is Your Brain on Trauma Chapter 4 Running for Your Life: the Anatomy of Survival > Being traumatized means continuing to organize your life as if the trauma were still going on—unchanged and immutable—as every new encounter or event is contaminated by the past. ([Location 1151](https://readwise.io/to_kindle?action=open&asin=B00G3L1C2K&location=1151)) > The most primitive part, the part that is already online when we are born, is the ancient animal brain, often called the reptilian brain. It is located in the brain stem, just above the place where our spinal cord enters the skull. The reptilian brain is responsible for all the things that newborn babies can do: eat, sleep, wake, cry, breathe; feel temperature, hunger, wetness, and pain; and rid the body of toxins by urinating and defecating. ([Location 1205](https://readwise.io/to_kindle?action=open&asin=B00G3L1C2K&location=1205)) > Right above the reptilian brain is the limbic system. It’s also known as the mammalian brain, because all animals that live in groups and nurture their young possess one. Development of this part of the brain truly takes off after a baby is born. It is the seat of the emotions, the monitor of danger, the judge of what is pleasurable or scary, the arbiter of what is or is not important for survival purposes. It is also a central command post for coping with the challenges of living within our complex social networks. ([Location 1215](https://readwise.io/to_kindle?action=open&asin=B00G3L1C2K&location=1215)) > Taken together the reptilian brain and limbic system make up what I’ll call the “emotional brain” throughout this book.[6] The emotional brain is at the heart of the central nervous system, and its key task is to look out for your welfare. ([Location 1232](https://readwise.io/to_kindle?action=open&asin=B00G3L1C2K&location=1232)) > trauma almost invariably involves not being seen, not being mirrored, and not being taken into account. Treatment needs to reactivate the capacity to safely mirror, and be mirrored, by others, but also to resist being hijacked by others’ negative emotions. ([Location 1272](https://readwise.io/to_kindle?action=open&asin=B00G3L1C2K&location=1272)) > The emotional brain has first dibs on interpreting incoming information. Sensory Information about the environment and body state received by the eyes, ears, touch, kinesthetic sense, etc. converges on the thalamus, where it is processed, and then passed on to the amygdala to interpret its emotional significance. This occurs with lightning speed. If a threat is detected the amygdala sends messages to the hypothalamus to secrete stress hormones to defend against that threat. The neuroscientist Joseph LeDoux calls this the low road.” The second neural pathway, the high road, runs from the thalamus, via the hippocampus and anterior cingulate, to the prefrontal cortex, the rational brain, for a conscious and much more refined interpretation. This takes several microseconds longer. ([Location 1317](https://readwise.io/to_kindle?action=open&asin=B00G3L1C2K&location=1317)) > If you want to manage your emotions better, your brain gives you two options: You can learn to regulate them from the top down or from the bottom up. ([Location 1360](https://readwise.io/to_kindle?action=open&asin=B00G3L1C2K&location=1360)) > Top-down regulation involves strengthening the capacity of the watchtower to monitor your body’s sensations. Mindfulness meditation and yoga can help with this. Bottom-up regulation involves recalibrating the autonomic nervous system, (which, as we have seen, originates in the brain stem). We can access the ANS through breath, movement, or touch. Breathing is one of the few body functions under both conscious and autonomic control. ([Location 1363](https://readwise.io/to_kindle?action=open&asin=B00G3L1C2K&location=1363)) #### Chapter 5 Body-Brain Connections > Pavlov interpreted this as a sign of ongoing terror, which had obliterated any curiosity in their surroundings. We now know that physical immobility and loss of curiosity are also typical of frightened, traumatized children and adults. ([Location 1607](https://readwise.io/to_kindle?action=open&asin=B00G3L1C2K&location=1607)) > He attributed these dramatic changes to “the existence of two conflicting physical impulses”: during the flood the caged dogs had been physically immobilized—trapped in their cages—while their bodies were programmed to run and escape in the face of life-threatening danger. This resulted in: “the collision between the two contrary processes: one of excitation and the other of inhibition, which were difficult to accommodate simultaneously…[which] causes a breakdown of equilibrium.”[5] This probably was the first time that a scientist described the phenomenon of “inescapable shock,” a physical condition in which the organism cannot do anything to affect the inevitable. As we have seen in chapter 2, confrontation with the reality that there is nothing one can do to stave off the inevitable leads to “learned helplessness,” a phenomenon that is critical for understanding and treating traumatized and humiliated human beings. ([Location 1614](https://readwise.io/to_kindle?action=open&asin=B00G3L1C2K&location=1614))